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Project RED The Re-Engineered Discharge. JCR’s AHRQ-funded Project Florida Hospital Association June 4, 2010 Deborah M. Nadzam, PhD, FAAN Project Director [email protected] - 630-261-5048. Discussion to include:. Background re: AHRQ Contract and task assignment to JCR

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Project RED The Re-Engineered Discharge

JCR’s AHRQ-funded Project

Florida Hospital Association

June 4, 2010

Deborah M. Nadzam, PhD, FAAN

Project Director

[email protected] - 630-261-5048

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Discussion to include:

  • Background re: AHRQ Contract and task assignment to JCR

  • Overview of Project RED intervention

  • Overview of JCR AHRQ-funded project

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AHRQ-funded Knowledge Transfer Project

  • Background

    • Knowledge Transfer/Implementation contract

  • Task assignment: Project RED intervention

  • Secure and support participation by 50 hospitals and health systems

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Explicit delineation of roles and responsibilities

Discharge process initiation upon admission

Patient education throughout hospitalization

Timely accurate information flow:

From PCP ► Among Hospital team ► Back to PCP

Complete patient discharge summary prior to discharge

Principles of the Newly Re-Engineered Hospital Discharge

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Comprehensive written discharge plan provided to patient prior to discharge

Discharge information in patient’s language and literacy level

Reinforcement of plan with patient after discharge

Availability of case management staff outside of limited daytime hours

Continuous quality improvement of discharge processes

Principles of the Newly Re-Engineered Hospital Discharge


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RED Checklist

Eleven mutually reinforcing components:

1. Medication reconciliation

2. Reconcile discharge plan with national guidelines

3. Follow-up appointments

4. Outstanding tests

5. Post-discharge services

6. Written discharge plan

7. What to do if problem arises

8. Patient education

9. Assess patient understanding

10. Discharge summary sent to PCP

11. Telephone reinforcement

Adopted by

National Quality Forum

as one of 30 US

"Safe Practices" (SP-15)

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Key to the Project RED Intervention:

  • Discharge Advocate

  • Care plan for patient use after discharge

  • Post-discharge follow up with patient

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Discharge Advocate (DA)

Notified when patients in target population are admitted/diagnosed

Initiates action steps associated with Project RED

Initiates Care Plan

Facilitates discharge planning rounds

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Discharge Advocate (cont.)

Educates patient and family about condition, medications , other treatments, post discharge plans, and follow up ordered by the physician

Reviews Care Plan with patient and family

Collects measurement data specific to project and patient population

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Discharge Advocate

  • Clinically Competent

  • Credible

  • Confident

  • Coordinator

  • Communicator

  • Connection with Patient

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11 RED Components Enable Discharge Advocates to:

Prepare patients for hospital discharge

Help patients safely transition from hospital to home

Promote patient self-health management

Support patients after discharge through follow-up phone call

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Sections of the Care Plan

  • Date of D/C; name and contact info for physician and D.A.

  • Medications

  • Pending tests and results

  • Follow-up appointments

  • Calendar

  • Other orders (diet, activity, etc)

  • Information about disease/condition

    • When and how to reach physician or go to E.D.

  • Form for writing own questions down

  • Map of campus for locating appointments

  • Other information about your center (optional)

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Post Discharge Follow-Up

  • Transmit D/C summary and care plan to PCP

    • Fax: insure it is received and legible

    • Electronic: scan/ email if possible; insure it is received

  • Follow-up phone call to patient-72 hours

    • Caller uses script inclusive of medication and follow-up appointment understanding

    • Need for second call by clinician determined

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Challenges to Implementation:Medical Team Related

Busy medical team; discharge receives low priority in the work schedule of inpatient clinicians

Discharge is relegated to least experienced team member

Last minute test / consultations resulting in delay of final discharge plan and medication list

Inaccurate medication reconciliation

Discharge medication reconciliation started on the day of discharge

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Challenges to Implementation:Hospital Related

Lack of resources and financial incentives to sustain discharge programs

Standardized discharge papers; not personalized or in language of patient

Resistance to change by clinicians

Financial pressure to fill beds as soon as they are empty 

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Challenges to Implementation:Patient Related

Patient without a Primary Care Physician

Limited or no insurance coverage

Inability to pay for medication co-pays

Long wait times when calling health centers

Late discharge; less effective teaching to patients who are anxious to leave

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Ready for Project RED?

  • Next Steps to participate in JCR Project

    • Secure leadership commitment

    • Identify targeted populations to begin

    • Determine approach for developing After Hospital Care Plan

    • Identify staff: Project Leader, Project Team, Physician Champion, Discharge Advocate(s)

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Project Expectations

  • Secure executive sponsorship

  • Assign project team and project leader

  • Identify targeted population of patients*

  • Determine approach for generating the care plan for patient’s use after D/C*

  • Identify discharge advocate(s) and staff to make post-discharge phone calls

  • Participate in pre-training conference call

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Project Expectations cont’d

  • Participate in web conference training

  • Schedule bi-weekly consulting calls with assigned JCR consultant

  • Provide data to JCR re: readmission, ALOS, patient satisfaction, resource investments, RED processes

  • Participate in all-site web conference discussions

  • Participate in case-study interviews

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Identify Targeted Patient Population

  • Start small!

  • Approaches to consider

    • Specific patient care unit

    • Diagnostic group

    • Physician’s patient group

    • Combination of above

  • Also

    • English-speaking patients

    • Discharged home

    • Access to telephone

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Generating the AHCP

  • “Manual” – use of template for discharge advocate (DA) to enter all required data

    • AHRQ template-

    • Mimic BMC’ AHCP

  • Provide template to your IT department and request that they integrate with existing systems

  • Purchase software and integrate it with your existing systems

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Timeline for Project

  • June - JCR-sponsored training begins

    • Recorded and live web conferences

    • Virtual Consultation begins

  • July – hospitals’ launch of Project RED intervention

    • Virtual Consultation continues-bi-weekly

    • Training for additional hospitals (launch in August)

  • August – December

    • Pilot implementation continues

    • Monthly measurement

    • Bi-weekly consultation

  • September - Web Conference for participants

  • October – Case study interviews

  • December – JCR-funding and support concludes

    • Hospitals continue and spread Project RED intervention!

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To participate in JCR’s AHRQ-funded project focused on Project RED

Contact Deborah Nadzam

[email protected]